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Rogers (1975, p.2) seminally described the skill of empathy as: ‘The ability to experience another person’s world as if it were one’s own, without losing the “as if” quality’. That means allowing ourselves to get into the patient’s shoes and experience some of what they might be experiencing, without allowing ourselves to enter the experience wholly (it isn’t our experience). Empathy allows for an opportunity to ‘taste’ and therefore attempt to understand the patient’s perspective. Understanding emotions and behaviours in this way encourages an acceptance and positive negotiation of them. Maintaining the ‘as if’ quality protects us from adopting too great an emotional load. Having too much of a sense of loss or sorrow may prevent us from offering effective support, as we are drawn to focus on our own feelings more than is necessary or helpful (for ourselves or the patient).

Empathy may not always come easily, especially if a patient is angry. What can be very useful in the development and use of empathy is the ability to step back from the situation and reflect upon what it is that you, as the nurse, feel and how this relates to what is happening for the patient.

Barriers to effective communication

Poor communication with patients can negatively affect decision making and quality of life (Fallowfield et al. 2001, Thorne et al. 2005).

The environmental conditions in which nurses work, with competing professional demands and time pressures, can reduce the capacity to form effective relationships with patients (Henderson et al. 2007).

There is a personal, emotional impact when providing a supportive role for patients with psychological and emotional issues (Botti et al. 2006, Dunne 2003, Turner et al. 2007) and it is therefore likely that blocking or avoidance of patients’ emotional concerns relates to emotional self-preservation for the nurse.

When communicating and assessing patient’s needs, nurses may be anxious about eliciting distress and managing expressed concerns. They may lack confidence in their ability to clarify patients’ feelings without ‘causing harm to the patient or getting into difficulty themselves’ (Booth et al. 1996, p.526). As a consequence, nurses can make assumptions, rather than assessing concerns properly (Booth et al. 1996, Kelsey 2005, Roberts and Snowball 1999, Schofield et al. 2008). To illustrate this point, Kruijver et al. 2001 demonstrated how nurses verbally focus upon physical issues, which accounted for 60% of communication with patients. Nurses often recognize this bias and suggest that they feel greater competence discussing physical rather than psychological issues and seek better skills to help them to manage challenging situations (McCaughan and Parahoo 2000). Being supported practically and emotionally by supervisors and/or senior staff can be seen to decrease blocking behaviours (Booth et al. 1996). Clinical supervision can aid the transfer of communication skills into practice (Heaven et al. 2006).

Institutions, work environments and the nature of the senior staff within them can influence the nature of communication (Booth et al. 1996, Chant et al. 2002, McCabe 2004, Menzies-Lyth 1988, Wilkinson 1991). Nurses may improve their own practice by identifying where environmental barriers lie and attempting to mitigate the features of the clinical environment that inhibit psychological care.

Despite the difficulties outlined, it has been argued that nurses can communicate well when they are facilitated to provide individual patient-focused care (McCabe 2004).

Legal and professional issues

Effective communication is central to a number of explicit standards of The Code (NMC 2008a) (see Appendix 1).

Make the care of people your first concern, treating them as individuals and respecting their dignity.

You must listen to the people in your care and respond to their concerns and preferences.

You must make arrangements to meet people’s language and communication needs.

You must share with people, in a way they can understand,